Biomechanics of the Temporomandibular Joint. TM joint에 대한 생체역학 - 정리중....

[문형철]

모든 관절에 대한 biomechanics에 대해서 찾아야겠다.

그리고 그 관절이 다른 관절에 미치는 생체역학적 관점, overload의 관점, 통증의 생성, pathology를 찾고

치료법에 대해 찾아야겠다.

그렇게 중요하다는 TM joint에 관한 생체역학 논문

TM joint 움직임의 functional mri(클릭)

턱관절질환은 상부교차증후군을 이해하고, 그것을 치료해야만 근본적인 치료에 도달할 수 있음.

Disc displacement is the most common TMJ arthropathy.

Almost 70% of TMD patients have disc displacement. 

panic bird....

Biomechanics of the Temporomandibular Joint.pdf

1. Introduction

Temporomandibular joint (TMJ) connects the mandible or the lower jaw to the skull and regulates the movement of the jaw (see Figure 1). The TMJ is one of the most complex, delicate and highly used joints in a human body (Alomar et al., 2007). The most important functions of the TMJ are mastication and speech. 

- 턱관절은 mandible과 두개골이 만나 이루는 관절

- 턱관절은 인체에서 가장 정교하고 많이 사용하는 그리고 가장 복잡한 관절, 

- 턱관절의 가장 중요한 기능은 씹기와 말하기. 

Temporomandibular disorder (TMD) is a generic term used for any problem concerning the jaw joint. Injury to the jaw, the TMJ, or muscles of the head and neck can cause TMD. Other possible causes include grinding or clenching the teeth; dislocation of the disc; presence of osteoarthritis or rheumatoid arthritis in the TMJ; stress, which can cause a person to tighten facial and jaw muscles or clench the teeth; aging (Bakke et al., 2001; Detamore et al., 2007; Ingawale and Goswami, 2009; Tanaka et al., 2000). 

- 턱관절 질환은 턱의 손상, 경추와 두부의 근육이 일으킴. 

- 다른 원인은 이악물기와 이갈기, 턱관절 디스크 탈구, 관절염, 류마티스 관절염 등이 원인 

The most common TMJ disorders are pain dysfunction syndrome, internal derangement, arthritis, and traumas (Breul et al., 1999; Chen et al., 1998). TMDs are seen most commonly in people between the ages of 20 and 40 years, and occur more often in women than in men (Detamore and Athanasiou, 2003; Detamore et al., 2007; Tanaka et al.,2008a). 

- 가장 흔한 턱관절 질환은 통증기능부전 증후군, internal derangement, 관절염, 타박상 등이 원인임. 

- 턱관절질환은 20-40사이에 가장 흔하고, 남자보다 여자에게 흔함. 

Some surveys have reported that 20-25% of the population exhibit one or more symptoms of TMD (Detamore et al., 2007; Ingawale and Goswami, 2009). With a large part of population suffering from TMDs, it is a problem that should be looked

at more fully. Relations between muscle tensions, jaw motions, bite and joint force, and craniofacial morphology are not fully understood. A large fraction of TMD causes are currently unexplained. There is a great need of better understanding of the etiology of TMDs to develop methods to prevent, diagnose, and cure joint disorders (Beek et al., 2003; Ingawale and Goswami, 2009). 

- 턱관절 질환의 증상은 20-25%에서 보임. 

- 턱관절 질환으로 고생하는 많은 환자는 ..

- 근육긴장, 턱움직임, 씹기 와 관절부하와 연관되어 두개안면 형태학은 충분히 이해되지 않음. 

This chapter provides a state-of-the-art review of TMJ anatomy, disorders, and biomechanics; and briefly discusses our approach toward three dimensional (3D) anatomical and finite element (FE) modeling to understand the interaction between structure and function of the TMJ.

- 이 챕터는 턱관절 해부학, 질환, 생체역학 정보를 제공함. 

Fig. 2. Normal anatomy of the jaw. The lateral view of the skull (Panel A) shows the normal position of the mandible in relation to the maxilla, the TMJ capsule, and the masticatory muscles – temporalis, masseter, mylohyoid, anterior and posterior digastrics, hyglossus, and stylohyoid. Also shown (Panels B and C) are the deep muscles associated with jaw function and the TMJ intra-articular disc.

2. TMJ anatomy and function

TMJ is a bi-condylar joint in which the condyles, the movable round upper ends of the mandible, function at the same time (see Figure 1). Between the condyle and the articular fossa is a disc made of fibrocartilage that acts as a cushion to absorb stress and allows the condyle to move easily when the mouth opens and closes (AAOMS, 2007; Ide et al., 1991). 

- 턱관절은 bi-condylar 관절. 

- 과상돌기와 관절와사이에 섬유성연골로 만들어진 디스크가 있어서 입을 열고 닫을때 충격을 흡수하는 역할수행. 

The bony structures consist of the articular fossa; the articular eminence, which is an anterior protuberance continuous with the fossa; and the condylar process of the mandible that rests within the fossa. The articular surfaces of the condyle and the fossa are covered with cartilage (Ide et al., 1991). The disc divides the joint cavity into two compartments -superior and inferior (Ide et al., 1991; Tanaka et al., 2008b). The two compartments of the joint are filled with synovial fluid which provides lubrication and nutrition to the joint structures (Tanaka et al., 2008b). The disc distributes the joint stresses over broader area thereby reducing the chances of concentration of the contact stresses at one point in the joint. 

- 턱관절에 있는 디스크는 관절강을 둘로 나누는 역할. 

- 활액이 가득한 관절로 관절구조에 영양과 윤활유를 제공함. 

The presence of the disc in the joint capsule prevents the bone-on-bone contact and the possible higher wear of the condylar head and the articular fossa (Beek et al., 2001; Tanaka et al., 2008b). The bones are held together with ligaments. These ligaments completely surround the TMJ forming the joint capsule.  

- 디스크가 있어 뼈와 뼈가 부딪히는 것을 막아줌. 

- 인대는 턱관절 낭을 완전히 둘러싸고 있음. 

Strong muscles control the movement of the jaw and the TMJ. The temporalis muscle which attaches to the temporal bone elevates the mandible. The masseter muscle closes the mouth and is the main muscle used in mastication (see Figure 2) (Hylander, 1979). Movement is guided by the shape of the bones, muscles, ligaments, and occlusion of the teeth. The TMJ undergoes hinge and gliding motion (Alomar et al., 2007). 

- 강한 근육이 턱관절의 움직임을 조절함. 

- 측두근은 측두골에 부착하여 하악골을 들어올림. 

- 교근은 입을 닫고, 주요 기능은 씹기임. 

- 턱관절은 경첩관절처럼 움직이고 활주움직임이 일어남. 

The TMJ movements are very complex as the joint has three degrees of freedom, with each of the degrees of freedom associated with a separate axis of rotation. Rotation and anterior translation are the two primary movements. Posterior translation and mediolateral translation are the other two possible movements of TMJ (Dutton, 2004). 

- 턱관절 움직임은 매우 복잡하여 자유도 3도의 관절임. 

- 회전과 전방 이동은 두가지 중요한 움직임. 후방이동과 내외측이동은 턱관절의 두가지 가능성있는 움직임. 

3. TMJ disorders and treatment

Temporomandibular disorder (TMD) is a generic term used for any problem concerning the jaw joint. Injury to the jaw, temporomandibular joint, or muscles of the head and neck can cause TMD. Other possible causes include grinding or clenching the teeth, which puts a lot of pressure on the TMJ; dislocation of the disc; presence of osteoarthritis or rheumatoid arthritis in the TMJ; stress, which can cause a person to tighten facial and jaw muscles or clench the teeth; aging, etc (Bakke et al., 2001; Detamore et al., 2007; Ingawale and Goswami, 2009; Tanaka et al., 2000). The most common TMJ disorders are pain dysfunction syndrome, internal derangement, arthritis, and traumas (Detamore and Athanasiou, 2003; Detamore et al., 2007). 

- 턱관절질환은 턱의 손상, 턱관절 또는 두부와 경부의 근육이 일으킴. 다른 원인은 이갈기, 이 악물기로 턱관절에 과한 부하를 초래할때 발생함. 

- 디스크의 탈구, 관절염, 류마티스 관절염 등

- 스트레스 부하, 나이 등

- 가장 흔한 턱관절 질환은 통증기능부전 증후군, intenal derangement, 관절염, 외상임. 

TMD is seen most commonly in people between the ages of 20 and 40 years, and occurs more often in women than in men (Detamore and Athanasiou, 2003; Detamore et al., 2007). Some surveys have reported that 20-25% of the population exhibit symptoms of TMD while it is estimated that 30 million Americans suffer from it, with approximately one million new patients diagnosed yearly (Detamore and Athanasiou, 2003; Detamore et al., 2007; Tanaka et al., 2008b; Wolford, 1997).

- 턱관절질환은 20-40대에 가장 흔하가 발생함. 남성보다는 여성에서 흔함. 

- 어떤 통계는 인구의 20-25%에서 턱관절 질환을 경험한다고 보고함. 

Disc displacement is the most common TMJ arthropathy and is defined as an abnormal relationship between the articular disc and condyle (Tanaka et al., 2000). As the disc is forced out of the correct position, there is often bone on bone contact which creates additional wear and tear on the joint, and often causes the TMD to worsen (Tanaka et al.,2000). 

- 디스크 전이는 가장 흔한 턱관절 질환임. 

- 디스크가 정확한 위치에서 벗어나는 힘이 발생하면, 뼈와 뼈의 부딪힘이 발생하고, 디스크가 깨지면서 턱관절 질환이 악화됨. 

Almost 70% of TMD patients have disc displacement (Detamore and Athanasiou, 2003). Different types of functional malocclusion have been shown to be partly responsible for signs and symptoms of TMD. The functional unilateral posterior cross-bite, habitual body posture during sleep, juvenile chronic arthritis - a chronic arthritis in childhood with an onset before the age of 16 years and a duration of more than three months – are also reported as TMD risk (Bakke et al., 2001; Hibi and Ueda, 2005; Pellizoni et al., 2006).

- 턱관절 질환의 70%는 디스크 전이임. 

- 기능적 부정교합의 서로다른 형태는 턱관절질환의 증상과 신호임. 

Treatments for the various TMJ disorders range from physical therapy and nonsurgical treatments to various surgical procedures. Usually the treatment begins with conservative, nonsurgical therapies first, with surgery left as the last option. The majority of TMD patients can be successfully treated by non-surgical therapies and surgical interventions may be required for only a small part of TMD population (Ingawale and Goswami, 2009).

The initial treatment does not always work and therefore more intense treatments such as joint replacement may be a future option (Ingawale and Goswami, 2009). The non-surgical treatment options include medication; self-care; physical therapy, to keep the synovial joint lubricated and to maintain full range of the jaw motion; wearing splints, the plastic mouthpieces that fit over the upper and lower teeth to prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth (Ingawale and Goswami, 2009). Splints are used to help control bruxism – a TMD risk factor in some cases (Glaros et al., 2007; Kalamir et al., 2007; Tanaka et al., 2000a). 

However, the long-term effectiveness of this therapy has been widely debated and remains controversial (Glaros et  al., 2007; Kalamir et al., 2007). Surgery can play an important role in the management of TMDs. Conditions that are always treated surgically involve problems of overdevelopment or underdevelopment of the mandible resulting from alterations of condylar growth, mandibular ankylosis, and benign and malignant tumors of the TMJ (Laskin et al., 2006).

The surgical treatments include arthrocentesis, arthroscopy, discectomy, and joint replacement. While more conservative treatments are preferred when possible, in severe cases or after multiple operations, the current end stage treatment is joint replacement (Tanaka et al., 2008b). However, before a joint replacement option is ever considered for a patient, all non-surgical, conservative treatment options must be exhausted; and all conservative surgical methodologies should be employed (Quinn, 199; Quinn, 2000). 

4. Biomechanical behavior of the TMJ

Mandibular motions result in static and dynamic loading in the TMJ. During natural loading of the joint, combinations of compressive, tensile, and shear loading occur on the articulating surfaces (Tanaka et al., 2008b). The analysis of mandibular biomechanics helps us understand the interaction of form and function, mechanism of TMDs; and aids in the improvement of the design and the behavior of prosthetic devices, thus increasing their treatment efficiency (Hansdottir and Bakke, 2004; Ingawale and Goswami, 2009; Korioth and Versluis, 1997) 

- 하악골 움직임은 턱관절에서 정적 그리고 동적 부하를 야기함

- 턱관절의 자연적인 부하동안, 압박, 장력 그리고 전단 부하가 관절면에 발생함. 

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좋은 자료 감사합니다.^^